As of April 2020, you've probably had it up to here with being told to wash your hands. At the same time, I assume you don't deny the obvious health benefits of washing your hands.
But how do you know it helps? Sure, you can cite your personal experience of seeing dirt wash away from the creases of your palms with your own eyes. If you're feeling pedantic, you can also cite various academic journals showing how a 30-second scrubbing with hot water and soap kills germs on your skin. But that's not what I mean.
I mean the question much more literally. How do you know? How do you know that you know?
What is the nature of knowing?
Here's the thing: epistemology, that is the study of knowledge – and not to be confused with the admittedly much more topical epidemiology – is not a trivial field of philosophy. Humankind has been grappling with reconciling its opinions about the world with reality since time immemorial.
A little, likely apocryphal anecdote comes to mind: an ancient Greek philosopher of some description catches one of his students drawing circles in the sand on the beach, studying the noble field of geometry.
The philosopher promptly slaps the student so hard that he falls over, then tramples all over the student's drawings. "Why are you drawing lines in the sand like some illiterate slave?" asks the philosopher. "You will never draw a perfect circle, no matter how hard you try. How could you possibly glean true insight from an imperfect facsimile of a circle? Close your eyes, imagine the circle, and go from there."
You've probably experienced this in your life: stick one hand into hot water, the other in cold water. After a while, put both hands into a third body of water of intermediate lukewarm temperature. One of your hands will feel that this water is cold; the other will tell your brain that it is hot, despite objectively being in the same water.
The human brain is a marvellous example of unintelligent design. Your senses lie, and your mind simplifies and approximates and foregoes detail wherever it can because its job is not to produce accurate data, but merely to keep you alive long enough for you to make and raise children.
Your body is a wonderful, awful, inefficient machine that is more or less a life support system for what may or may not be between your legs.
How can, then, we be sure of anything, if everything we think we're sure of has, inevitably, to be filtered through our imperfect senses?
The idea that there might exist a means to truly ascertain things about the universe – or at least get as close as physically possible – is actually quite novel, and we as a species haven't been applying it on a large scale for very long. We call that means the scientific method.
Fundamentally, the scientific method rests on the principle of empiricism: the idea that objective truths can be gained by experimental tests, and the results of those tests can be independently verified by human senses.
The ancient Greeks, who famously rejected empiricism, were nonetheless able to figure out not only that the Earth is round, but its radius, as well as the size and distance of the Sun and the Moon. They birthed European civilisation and culture; they gave us democracy; they laid down the foundations of mathematics and geometry and, indeed, science.
However, they also thought that blood exists to cool the body, that memories are stored in the heart, that all things eventually stop moving unless some force acts on them, that vacuum cannot exist, that either the Earth or the Sun exists at the centre of a tiny, human-centric universe, and they were so terrified of irrational numbers that they outright refused to acknowledge their existence.
It took humanity thousands of years to fully embrace empiricism and finally begin debunking some long-held beliefs.
That is why when in 1847 a certain Ignaz Semmelweis suggested that perhaps doctors, who'd just been fiddling about the insides of deceased humans, ought to wash their hands before sticking them inside mothers so as to help them give birth, he was laughed out of the room.
Semmelweis was an obstetrician working in Vienna who observed that the mortality rates of puerperal fever – deadly infection following childbirth – were much higher in one clinic of the Vienna General Hospital than another.
In one of the hospital's maternity clinics, where trainee doctors practised, the maternal mortality rate due to postpartum infections was up to 10%. At the other clinic, where strictly midwives only practised, that rate was less than half, 4%. And the thing is, no-one knew why.
The former clinic's mortality rates, for reference, were so bad that giving birth on the streets was in fact statistically safer; Semmelweis himself described heavily pregnant women begging on their knees to be admitted into the midwives' clinic rather than be helped in the doctors' clinic.
This was before the widespread acceptance of the germ theory of infection. Although the idea had existed for a while, and papers had even already been published about it, it was still not accepted in Europe.
It was Semmelweis who, after eliminating all possible differences, recognised that the medical students working at the first clinic often performed autopsies for their studies, and they also tended to go from autopsy to childbirth to autopsy without a second thought.
The answer to the mystery seemed obvious: the doctors were infecting the women, carrying disease from the corpses directly to the mothers, and Semmelweis had the empirical data to prove it. All the doctors had to do to save these mothers from dying in agony was wash their own hands.
A comparison of puerperal fever mortality at the Wien (Vienna) maternity clinic vs the Dublin maternity hospital.
The first vertical line, at 1824, marks the adoption of autopsies at the Vienna clinic; autopsies were not adopted at the Dublin hospital.
The second vertical line, in 1848, shows the adoption of chlorine handwashing in Vienna.
(Image source: Wikimedia commons, public domain)
No-one believed Semmelweis.
But how could it be so? These were intelligent men, educated men, doctors, post-enlightenment, at the doorstep of modernity in the mid-19th century. How could they, then, reject the obvious?
Here's the thing: Semmelweis's peers, who dismissed him as a madman for his suggestion of handwashing, fancied themselves empiricists.
They believed in reason and empirical evidence. That was the very reason they spent so much time up to their elbows in corpses: they were analysing the insides of the dead in hopes of discovering what killed them and how. Without these pioneers of scientific autopsy, we might still think that blood cools the body or that the heart stores memories.
Who was Semmelweis, anyway, this nobody, to say that the entire medical community of Europe was wrong, and he was right?
To them, Semmelweis's hypothesis that there existed these evil, invisible "corpse particles" that turned people also into corpses upon touch, but never the doctors and only the women, sounded like the ravings of a self-important lunatic.
And let's be honest, it does sound a lot sillier when you put it like that.
History would of course prove Semmelweis right. Today, he is called the Saviour of Mothers (a nickname that, to those of you who've read What a Time to Be Alice!, will explain why I named a particular character after Semmelweis) and his name is synonymous with reason and an unyielding desire to uncover truth in the face of overwhelming resistance – and how such strength of will can turn on itself and consume a person.
For Semmelweis was never acknowledged in his life. Instead he was ridiculed and ostracised by the medical community for his insistence. He became obsessed with childbed fever and infection; Semmelweis may very well be the first documented case of germophobia, or at least some sort of madness induced by an all too keen awareness of the inescapable presence of germs. He would denounce his peers as murderers in various, increasingly polemic publications, became an embarrassment to his colleagues, took up drinking, and cheated on and grew estranged from his wife.
In 1865, Ignaz Semmelweis finally passed due to a gangrenous infection suffered upon being severely beaten by the guards of an insane asylum to which he'd been committed.
As with most of human history, Semmelweis's is a tragic story. His story is also a microcosm of human history: a constant struggle of ideas, of missteps with fatal, long-lasting consequences, yet, often, with positive if belated results. History proved Semmelweis right.
Human progress is slow, it is difficult, and it buries far too many great people along the way. But it is happening.
Let me tell you yet another very depressing story.
While writing this blog I made one of my favourite mistakes: I read the news. Under the expected deluge or coronavirus-related news, there was a brief article about a murder. It happened not far from where I live, the night before, on a tram line I often take. The victim was a young man my age.
According to the article, the victim was travelling by tram with a friend and his dog in his lap. A group of three got onto the tram at one stop and immediately began to harass the friends and the dog. Multiple requests to stop fell on deaf ears.
The back-and-forth escalated until one of the three perpetrators pulled out a knife and stabbed the victim in the chest. The group got off at the next stop and fled. The man died there in his friend's arms whilst his frightened dog ran away.
The perpetrators were found within hours. All three of them are homeless; all three of them with a criminal record; one of them makes a living by prostitution; one of them only got out of prison this January.
It could have been me. It could genuinely have been me. A horrifying, senseless waste of life, committed by a group of people who are, in all likelihood, beyond help. And it's hardly a unique case; things like this happen every day around the world.
It makes me feel helpless. It makes me feel stupid, stupid for believing in some sort of higher ideal.
See, I consider myself a humanist; I believe in the inherent value of human life, or at least try to. It's at times like this when I'm forced to question my convictions.
I think it helps, in times like this, to remember Semmelweis. Semmelweis insisted on the data, on what was real, on what was actually happening; he didn't look at the deaths of the mothers at his hospital and shrug and accept it. He wanted to know why.
No amount of reason could have stopped the murder on the tram. No draconian police state could have prevented this. As demonstrated by various other countries, even the death penalty does not deter people like this. If firearms were easy to legally acquire, people like this could get them too.
I don't know the story of the three perpetrators; I don't know how they ended up so thoroughly broken inside that human life means so little to them. I can make guesses: poverty, alcohol, drugs, abusive or absent families, a lack of education, or various combinations of these.
Statistically, all of the things on the above list are improving. Perhaps not locally, and perhaps not every year, but they are improving.
A brief comparison of various statistics from around the globe. Click to enlarge and cycle through the figures.
We cannot stop every individual crime from being committed, but we can stamp out the circumstances that give birth to them. And we are. Very, very slowly.
That's what I think about in times like this. I try to look at not just what happened on that night on that tram; I try to look at broad trends and, with them, into the future. I hope to live long enough to see those positive trends continue.
I hope that future generations will consider our time as harsh and unenlightened as we see the time of Semmelweis. I hope that future generations will see that, like Semmelweis and all other proponents of germ theory, we've been trying.
We are trying.
It is a bumpy road. Some decades are worse than others. Yet there is progress.
The three people who murdered that innocent man might never understand why what they did was wrong. They might be, maybe through no fault of their own, incapable of rehabilitation. In our current justice system, they certainly are, anyway.
They're not like the peers of Semmelweis, who had no excuse. They were intelligent and educated and prided themselves on adhering to science and empirical knowledge. Yet when the truth came knocking on their door, they rejected it out of that same pride and drove one of the brightest minds of their generation to complete mental breakdown.
Yet here we are, washing our hands. If we interpret humanity as a single superorganism, we'll see that it is a self-correcting system. Good practices tend to spread and grow and develop further whilst bad ones die out; change does come, even if it must step over corpses to do so.
That's what made us as a species what we are. In prehistory, those who failed to pick up agriculture were wiped out by the people who did pick it up. Throughout recorded history, all those who rejected advancement – or were simply too late to pick up – were conquered or assimilated.
There have always been people and cultures who opposed progress. To date, they have always failed.
When I outlined these thoughts to a friend of mine, he accused me of, to quote his exact words, vapid idealism. Sometimes even I worry if I've fallen victim to it. I'm worried my friend might be correct. But is it really idealism if it is based on facts? By all measurable metrics, things are getting better.
Whether you're a renowned doctor or societal outcast, peasant or king or emperor or pope, one thing has always held true:
You can't stop the future.
Semmelweis's story may be over, but history is not. There is nothing we can do to add to the story of Semmelweis. All we can do is move on, following the march of history, and remember.
Remember the Saviour of Mothers. Remember that sometimes, even the smartest, most renowned intelligentsia can get something fatally wrong; remember that human knowledge is a fickle thing, subject to change and revision; remember to always look at the data and the facts instead of relying on pride and intuition. For all the flaws of our gullible human senses, they are still the best tools – the only tools – that enable us to learn how our world really works, and with that, learn how to cultivate this world for the betterment of all of humanity.
Remember Semmelweis. And please, in this time of a pandemic, remember to wash your hands. The future of humanity depends on it. No, really.